Ultra Sensitive PSA

Well,

Got my 9 month PSA and it went from .003 to .005 so I was understandably concerned even though it was still very low. Found out that the testing facility adjusted their protocol to a limit of .005 so I was still at the lowest possible figure they could detect. That was a major relief. I did some further studying of my physicians website and uncovered the following information as well.

They state that if you have an initial PSA after 6 weeks that is =0.01 you have a 99.2% chance of cure even with long term follow up. Conversely, you have a significantly higher risk of BCR if you don't achieve such a low level.

Also, the .005 protocol allows you to observe a rising PSA much sooner and can lead to SRT being much more effective. I guess I'm lucky that my doctor uses the ultra sensitive. It definitely puts me more at ease.

On a side note, got an ambimed inject ease and will try using it tonight. I'm not much for needles but by golly, its for a good cause. If anyone has experience with it let me know. I'm going to jet and get some alcohol swabs. Will check for replies when I get back!

T40

Just curious..I know that standard assays are to the tenths (0.1) and usually post surgical start out at the hundredths (0.01)...but down to the thousands (0.001). I dunno but wouldn't the psa fluctuate up and down naturally at that level from things other than prostate cancer or benign prostate tissue? Wouldn't this lower level just add to the post-op psa anxiety as a result?

Would seem to me, that most doctors would dismiss anything in the 0.00X area until it rises significantly to the hundredths or even tenths before beginning to take a closer look at possible recurrence.

Secondly, precision costs...does your insurance cover the additional cost?

BTW congrats on the low psa tests. May you have a lifetime of them

David:

You are correct.

.003/.004--it's all very good. No need to worry about that kind of movement.

Mel

precision doesn't seem to cost at this point. The psa test was like $159 and after insurance it came out to $14 and change.

On a side note, the inject ease worked perfectly. Self injections now no big deal. Sure did make a big deal out of it for myself so when I actually did it felt like a moron because it was so easy.

Jeff, do you mean to say that you are injecting the needle thru a layer of solarcaine, hence introducing a non-sterile field, or the solarcaine first, then the alcohol swab to seralize it?

I understand that there are some super sensitive PSA tests out there.. so they break down to a finer number. But even on this board I see talk of post op psa from .003, to perhaps .05 as being acceptable (or palatable, I guess),,, yet I see urologists out there saying "A value of 0.2 or 0.1ng/ml would be considered essentially zero": http://www.drcatalona.com/qa/faq_post-op.asp . Ironically, as I write this, my urologist office calls and says I am 0.1 - and says THAT IS GREAT News. He says the urologist considers that "machine noise" and it is the most common result they get after doing RP. So I see 1.0 and folks saying sorry, and I get 1.0 and they tell me Congrats.??

p.s. Had my path meeting yesterday, some of my prostate was Gleason "5".. wow. It was 75% involved. Urologist brought it before the "GU Tumor Board".. group of experts at Boston University Hospital, hey tells me (and writes). He said he was REALLY surprised it was as aggressives as it was.. tells me in March the biopsy indicated 25% involvement, and by May 17 it was 75% involved..

So that's my good news bad news good news bad news story for this hour. Thanks.r

Hi Worried (more than a few of us could have chosen that name).... You are correct, I stated it wrong at the end... I am 0.1. YES, HUGE difference I know! but that kinda goes to my point. I was called and told by my dr's nurse it was "0.1".. I had her repeat it. My urologist's assistant calls me and he confirmed it was "0.1". He said that was the lowest low reading they get, so he felt it was good news. He said they do the test there at BMC. I said "so you dont use the highly sensitive machine".. he didn't know. That troubles me a touch, though I am comfortable this is a capable dr and institution, and they handle a substantial # of PC cases. But one would hope they knew that important variable (I'm sure my urologist knows, but his key assistants should as well, if they are going to deliver the reults to the patient, which I may mention to them as feedback).

I just had the RP on May 17, on June 17 he did the PSA during same meeting as pathology results.. and I think we agree that RT is my next move.. and I meet with them on Tue. BUT TO MY INITIAL POINT RE THE PSA... I hear some say that 0.1 is good, and other are speak like it's too bad you got 0.1.. THIS dr states that he considers 0.1 to be ZERO: http://www.drcatalona.com/qa/faq_post-op.asp HE SAYS "Therefore, we consider any PSA value less than 0.2 as being negligible".

So I dont know what to think... Apples & Oranges? The machine that reads "0.1" likely does not have the capacity to read "0.03".. so it give A reading?

Hey Bob,
My big problem with the single decimal machine is this. Imagine you have a progression every two months of .06, .08, .10, 0.12, 0.14 and maybe even 0.16. All of those values would be reported as 0.1 You be sitting fat, dumb, and happy for more than a year and then bam! you get a 0.2 that they might or might not consider noise. Do you really want to wait that many months before maybe thinking about doing something else? I am sure the Uro would not if it was for himself or a family member. If you have to go to a place without 2 decimal capability then a "<0.1" is a great score. A "0.1" is only great for someone on the other side of the prostate.
It is 2010. Time to find a place that does two decimals. It matters. (Or are you still driving a car with a carburetor?)

Jeff

I found a Topic on this site "just what is undectable psa after surgery?":

in 2008 TimG wrote:
"The standard PSA has a lower detection limit of 0.1 ng/mL, so anything below that is reported as less than 0.1 (<0.1). Ultra-sensitive tests go lower and usually report to the nearest hundredth rather than the nearest tenth, for example, 0.02. The detectable limit is lower as well.

Having written that, I opted to go with the standard PSA test for two reasons (1) I don't plan to consider any salvage radiation unless the PSA is above 0.1 and (2) there is so much noise in the ultra-low test results below 0.1 I don't want to experience undue anxiety by seeing a report that shows a rising PSA, say 0.02 to 0.04 that may in fact be simply test variation and insignificant."

*I'll have to think a little more on the points he makes before deciding howm I personally feel about this.

Jeff. I plan to start making some phone calls. Because I have heard and do believe that there is a "noise" factor, i'm not sure I would want to go through .002 to .003, but I ABSOLUTELY believe that 0.02 and 0.06, for example, could not be attributed to "noise", hence DOES matter. I assure you Jeff, my reasoning for trying to uinderstand the variables involved here were not measured by "do I want to know, or do I want to hide it under the rug"... My concern was that if the machine(s) vary and cannot consistantly calibrate to the .000, then I dont want to be held captive to the variance of .002 and .003.

Back to my original concenr, when MY uro, who is head of urology at this well know local institution, gives me a result of 0.1, and then I see others (I use this example: http://www.drcatalona.com/qa/faq_post-op.asp ) ALSO saying that "0.1" is considered by THEM EACH to be ZERO, yet THEN I see folks on here saying "wow, too bad you got a 0.1" - then something is wrong.

Trained urologists saying 0.1 is effectively zero, then untrained patients saying it's a bad grade. So, I welve to find out. I WILL ASK MORE QUESTIONS.. I WILL demand better answers. But it seems that - There is some inconsistancies in what trianed doctors are saying VS what some here are sayin, and ALSO between capabilities of the machines. I'm not ready to suggest there is some great consiracy here.

I MAY find out that the assistant I spoke with simply didn't know enough to gove me the correct reading, with the "<", or MAYBE, my result was 0.100 exact, or maybe the initial PSA is OK being at 0.1 due to "noise" and gets more detailed thereafter. I understand there could be natural psa found in the body even after the prostate is removed, so that needs to be accounted for. Some here (and elsewhere) suggest that it is the pace (velocity) of the increase that is most important, and mnot the inital post op psa number.

I dont know, but i'm planning to learn. 3 months ago I didn't know what a prostate was.. now I know more than I care too.. with more than I can image left to be learned.

MY PRAYERS WITH ALL OF YOU, AND HAPPY FATHERS DAY TO EACH OF YOU, AND/ OR YOUR FATHERS, AND SONS!

I dunno, mebe this will kick the ball a little closer to the goal --

http://prostatecancerinfolink.net/diagnosis/psa-testing/different-psa-
tests/

fogball

Thanks to all. Ed, that is right the the point of one of the problems... one machine gave you a .004, and another machine came back at .005... and you're "not worried yet about the slight increase"... But that number is soooooooo fine, that it is likely THE EXACT SAME RESULT... No Increase Whatsover, simmply two different machine that are calibrated to round off differently or something. Not worried yet indicates the time will come where that specific .001 difference will cause you some worry..

Stiil, I get back to my uro, having done 1,000+ of these, telling me that 0.1 is great and it's the lowest they grade. Just doesn't make sense. But i'll get to the bottom of it.

Happy Fathers day to all.. I will say a prayer for all of use tonight who deal with this issue through no fault of our own.